Remember those days when you were asked a question by the director, and you were just relieved to get the answer, and then you were hit over the head with a follow-up question? It’s all about growth!
Why are myocardial infarction patients prone to arrhythmias?
@ Op****hua: Why are patients with myocardial infarction prone to arrhythmias?
- ischemia and hypoxia processes occur in myocardial infarction, causing myocardial cells to depolarize and repolarize abnormally
- Ischemia, injury and necrosis of myocardial cells and fibrous tissue form scar tissue, resulting in abnormal electrical impulses and conduction
- Sensitivity to ionic disturbances after myocardial infarction makes it easy to develop arrhythmias.
What is the mechanism of atrial defect murmur generation?
@Chen*: What is the mechanism of murmur generation in atrial defect?
Would the first thing people feel is that it is because of atrial defect?
When I studied internal Medicine, I also thought so because I glanced at it at that Time, and it was not tested in the exam, but after I studied pediatrics, I thought carefully about its cause.
The murmur produced by ASD should be an atrial systolic murmur (that is, a diastolic murmur), but its typical manifestation is a grade II-III systolic blowing murmur heard between the 2nd and 3rd ribs at the left edge of the sternum, accompanied by a hyperactive second heart sound and a fixed split, looking at the grade of the murmur is not typically caused by organic pathology, not in line with ASD, so that this murmur is actually due to atrial left-to-right shunt, resulting in The right ventricular volume increases and the pulmonary valve blood flow velocity increases during cardiac contraction.
Can all sudden deaths be treated with epinephrine?
@Wu***jm: One day, after resuscitating a patient who died of multiple organ failure, we returned to the office and the director asked: can all patients who die suddenly use epinephrine?
See no one answered, the director said: take antipsychotic drugs (such as chlorpromazine and other drugs with alpha receptor antagonism) of the patient died suddenly, can not use epinephrine.
Epinephrine agonizes both alpha and beta receptors, acting on myocardial beta1 receptors to enhance myocardial contractility, accelerate conduction and heart rate, and increase myocardial excitability; acting on macrovascular alpha receptors to constrict blood vessels and raise blood pressure. However, many antipsychotic drugs, such as chlorpromazine, have α-receptor antagonism, and the application of epinephrine at this time will not only fail to raise blood pressure, but also lead to a further decrease in blood pressure.
The application of alpha-blocking drugs will eliminate the role of epinephrine agonizing alpha receptors to constrict blood vessels, while the role of epinephrine agonizing beta2 receptors to dilate blood vessels will be fully expressed, then the original blood pressure dose of epinephrine can cause a simple drop in blood pressure, this phenomenon is called the reversal of the effect of epinephrine boost.
Why do I need digitalis when my pulse is in the normal range?
@yue*1018: Why do I need digitalis when my pulse rate is in the normal range?
Short and sweet version of the answer: because the pulse is short!
The detailed version: Atrial fibrillation pulse rate will be less than the heart rate, there may be a normal pulse but the heart rate is still very fast, then the use of digitalis to control the heart rate.
Gastrofluid is prohibited in patients with gastrointestinal bleeding?
@yu****ote: Why is gastrofacial contraindicated in patients with gastrointestinal bleeding?
The reason is that the effect of Gastrofluan on the gastrointestinal tract is mainly in the upper gastrointestinal tract, promoting the movement of the stomach and upper intestinal segment; increasing the tone of the resting gastrointestinal sphincter, increasing the tone and contraction of the lower esophageal sphincter, increasing the pressure of the lower esophagus, blocking gastroesophageal reflux, strengthening gastric and esophageal peristalsis, and enhancing the ability to contour the contents of the esophagus, promoting gastric emptying. Promotes relaxation of the pylorus, duodenum and upper jejunum, and creates functional coordination between the gastric sinus, gastric body and upper small intestine.
Therefore, patients with gastrointestinal bleeding may be aggravated by the use of Gastroflucan and therefore should not be used.
What is the best way to control the pH in the stomach to cure HP?
@blue****tal24
Director’s question: Why is PPI used in upper gastrointestinal bleeding caused by peptic ulcer?
Answer: The use of PPI can rapidly increase the pH of the stomach, and at the same time promote platelet aggregation and clotting, which is conducive to clot formation and inhibits fibrinolysis.
Q: What is the best pH value to control in general?
Answer: pH>6
Satisfactory answer
Then conclude: When peptic ulcer causes bleeding in the upper gastrointestinal tract, measure the pH value in the stomach to see if the acid-suppressing effect is not enough. Low pH is not conducive to platelet aggregation and clot formation, and inhibits fibrinolysis, which affects the hemostatic effect.
Another question: What is the best pH to control in the stomach to cure HP, peptic ulcer, and reflux esophagitis?
No one answered: pH >3, pH >4, pH >5.
How is liver cancer diagnosed?
@hua*nfeng: I heard a veteran director tell me the experience of diagnosing liver cancer during his checkup.
- listen to the vascular murmur in the liver area
- repeatedly comparing the temperature of the skin of the quarter ribs on both sides to see if they are equal
The strongest summary of extubation indications
@ys***09: What are the indications for extubation after common bile duct exploration and T-tube drainage?
The director summarized it very concisely in four words: first class (2 weeks), second class (normal temperature, no jaundice, abdominal pain, etc.), third class (clear bile drainage fluid), fourth class (T-tube imaging is clear, no discomfort after T-tube clamping).
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